Child Health Management Services

Child Health Management Services (CHMS) clinics provide both developmental and medically focused treatment for children who are Arkansas Medicaid beneficiaries and who meet the qualifying criteria. These services are available in a day school setting and include physician and nursing services, physical therapy, occupational therapy, speech therapy, nutrition, early childhood developmental teaching and psychological services. CHMS services are intended for children with the most significant medical and/or developmental diagnoses who require multidisciplinary treatment.

Prior authorization is required for all treatment services provided in a CHMS clinic. To request prior authorization, please send the following documentation to AFMC along with the completed DMS-102. Request for Authorization of Child Health Management Services form:

A treatment plan signed by the CHMS medical director and the child’s PCP that includes all services to be provided in the clinic

The most recent evaluations along with documentation to support the child’s current medical and/or developmental status

CHMS enrollment orders signed and dated by the CHMS medical director and the PCP

DMS-640 prescription for occupational, physical, speech therapy

Please refer to Section II of the Medicaid Child Health Management Services Manual found on Arkansas Medicaid’s Web site for complete program information.

AFMC review process

If the nurse reviewer is unable to approve medical necessity of the requested service, the review is referred to a physician advisor for determination. AFMC utilizes actively practicing physicians who are licensed in the state of Arkansas to review the prior authorization requests. The physician advisor uses his/her medical judgment in accordance with established Medicaid policies to review medical necessity of the requested services.

Review notifications

Upon completion of each prior authorization request, AFMC provides written notification of the review determination to the requesting provider and the Medicaid beneficiary.

Approval notifications – include each procedure code/modifiers and units approved along with the authorization number for billing

Denial notifications – include case-specific clinical rationale and detailed information about how to appeal the determination, including the time frame allowed for submission and the requirement to provide additional information to support the medical necessity of the service denied.

Due process rights

If AFMC is unable to fully approve any requested service, all applicable parties are notified in writing of the review determination along with detailed information regarding their due process rights.

Reconsideration requests

The provider may request reconsideration of the AFMC decision within 35 calendar days of the date on the review notification letter. Requests must include a copy of the denial letter and additional documentation to substantiate the medical necessity of the requested services. Requests received after 35 calendar days of the denial date will not be accepted for reconsideration.

If the denial decision is reversed during the reconsideration review, an approval is forwarded to the provider and Medicaid beneficiary specifying the approved units and services. If the denial decision is upheld, the provider and the Medicaid beneficiary will be notified in writing of the review determination. Reconsideration is available only once per prior authorization request.

Appeal hearing requests

Medicaid beneficiaries may request an appeal of the AFMC decision through the Office of Appeals and Hearings. The appeal request sent to the Appeals and Hearings Section of DHS within 35 calendar days of the date on the denial letter.

How to protect yourself

AFMC will protect your privacy as described in this Privacy Statement, however, you should keep in mind that if you voluntarily disclose personal information, especially confidential health information, it is possible that despite our efforts, information may be accessible by others. You can help guard against this by: